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HEATHER'S STORY

Heather Bone was 39 when she was diagnosed with inflammatory breast cancer. She had little symptoms apart from a swollen hand which slowly grew up her arm. Finally she was diagnosed and as it is an aggressive cancer, chemo started quickly, followed by a mastectomy and she was cleared of cancer 6 months later. Sadly a few months later, Heather was suffering from bad headaches and went for more tests and discovered the cancer had spread to her brain and that no more treatment was possible. Sadly Heather only has a few months left to live and will leave behind her husband Dan and her two young sons Lewis and Marcus. She remains super positive and plans on living her last months to the full.

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WHAT IS INFLAMMATORY BREAST CANCER?

Inflammatory breast cancer cells grow along tiny channels (lymph vessels) in the skin of the breast. These cells block the lymph vessels. These vessels are part of the lymphatic system. They drain fluid from tissues, collecting and filtering out bacteria and any waste materials from the body’s cells.

Inflammatory breast cancer is rare. It is called inflammatory breast cancer because the breast becomes inflamed and swollen. This is because the body is reacting to the cancer cells in the lymph vessels.

Unlike other breast cancers, you may not feel a lump.

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SYMPTOMS OF INFLAMMATORY BREAST CANCER

Symptoms often develop quite suddenly. The breast may become:

• red and inflamed
• firm
• swollen
• hot to touch.

Other symptoms may include:

• ridges or raised marks on the skin of the breast
• pitted skin, like the peel of an orange (known as peau d’orange)
• a lump or thickening in the breast
• pain in the breast or nipple
• discharge from the nipple.

The symptoms of inflammatory breast cancer are similar to an infection of the breast (mastitis).

If your GP thinks that you could have mastitis, they may give you antibiotics to see if symptoms improve. Mastitis is uncommon in women who are not pregnant or breast feeding. It is also rare in women who have been through the menopause.

Antibiotics for mastitis normally improve symptoms quickly. If this does not happen, your GP will refer you to a specialist breast cancer doctor.

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HOW IS INFLAMMATORY BREAST CANCER TREATED?

How is inflammatory breast cancer treated?

Inflammatory breast cancer is generally treated first with systemic chemotherapy to help shrink the tumor, then with surgery to remove the tumor, followed by radiation therapy. This approach to treatment is called a multimodal approach. Studies have found that women with inflammatory breast cancer who are treated with a multimodal approach have better responses to therapy and longer survival. Treatments used in a multimodal approach may include those described below.

• Neoadjuvant chemotherapy: This type of chemotherapy is given before surgery and usually includes both anthracycline and taxane drugs. Doctors generally recommend that at least six cycles of neoadjuvant chemotherapy be given over the course of 4 to 6 months before the tumor is removed, unless the disease continues to progress during this time and doctors decide that surgery should not be delayed.
• Targeted therapy: Inflammatory breast cancers often produce greater than normal amounts of the HER2 protein, which means that drugs such as trastuzumab (Herceptin) that target this protein may be used to treat them. Anti-HER2 therapy can be given both as part of neoadjuvant therapy and after surgery (adjuvant therapy).
• Hormone therapy: If the cells of a woman’s inflammatory breast cancer contain hormone receptors, hormone therapy is another treatment option. Drugs such as tamoxifen, which prevent estrogen from binding to its receptor, and aromatase inhibitors such as letrozole, which block the body’s ability to make estrogen, can cause estrogen-dependent cancer cells to stop growing and die.
• Surgery: The standard surgery for inflammatory breast cancer is a modified radical mastectomy. This surgery involves removal of the entire affected breast and most or all of the lymph nodes under the adjacent arm. Often, the lining over the underlying chest muscles is also removed, but the chest muscles are preserved. Sometimes, however, the smaller chest muscle (pectoralis minor) may be removed, too.
• Radiation therapy: Post-mastectomy radiation therapy to the chest wall under the breast that was removed is a standard part of multimodal therapy for inflammatory breast cancer. If a woman received trastuzumab before surgery, she may continue to receive it during postoperative radiation therapy. Breast reconstruction can be performed in women with inflammatory breast cancer, but, due to the importance of radiation therapy in treating this disease, experts generally recommend delayed reconstruction.
• Adjuvant therapy: Adjuvant systemic therapy may be given after surgery to reduce the chance of cancer recurrence. This therapy may include additional chemotherapy, hormone therapy, targeted therapy (such as trastuzumab), or some combination of these treatments.

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Information sourced from Macmillan and National Cancer Institute

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